Maternal alcohol use and neonatal habituation assessed with the Brazelton scale

Newborn behavioral effects of intrauterine alcohol exposure were examined in 417 infants given the Brazelton Neonatal Assessment Scale. In this longitudinal prospective study, maternal alcohol use was obtained by self-report during the fifth month of pregnancy. Factor analysis of the Brazelton scale yielded 6 factors that were entered into a multiple regression analysis as dependent variables. Maternal alcohol use in mid-pregnancy was significantly related to poorer habituation and increased low arousal in newborn infants, even after adjusting for smoking and caffeine use by mothers, maternal age and nutrition during pregnancy, sex and age of the infant, and obstetric medication. This study lends further support to recognition of maternal alcohol use during pregnancy as a risk factor for alterations in newborn behavior.     

Maltreatment in childhood and intimate partner violence: A latent class growth analysis in a South African pregnancy cohort

Intimate partner violence (IPV) is a significant global problem, prevalent in low and middle-income countries (LMICs). IPV is particularly problematic during the perinatal and early postnatal period, where it is linked with negative maternal and child health outcomes. There has been little examination of profiles of IPV and early life adversity in LMIC contexts. We aimed to characterize longitudinal IPV and to investigate maternal maltreatment in childhood as a predictor of IPV exposure during pregnancy and postnatally in a low resource setting. This study was nested in the Drakenstein Child Health Study, a longitudinal birth cohort. Maternal IPV (emotional, physical and sexual) was measured at six timepoints from pregnancy to two years postpartum (n = 832); sociodemographic variables and maternal maltreatment in childhood were measured antenatally at 28–32 weeks’ gestation. Associations between maternal maltreatment in childhood and IPV latent class membership (to identify patterns of maternal IPV exposure) were estimated using multinomial and logistic regression. We observed high levels of maternal maltreatment during childhood (34%) and IPV during pregnancy (33%). In latent class analysis separating by IPV sub-type, two latent classes of no/low and moderate sexual IPV and three classes of low, moderate, and high emotional and physical IPV (separately) were detected. In combined latent class analysis, including all IPV sub-types together, a low, moderate and high exposure class emerged as well as a high antenatal/decreasing postnatal class. Moderate and high classes for all IPV sub-types and combined analysis showed stable intensity profiles. Maternal childhood sexual abuse, physical abuse and neglect, and emotional abuse predicted membership in high IPV classes, across all domains of IPV (aORs between 1.99 and 5.86). Maternal maltreatment in childhood was associated with increased probability of experiencing high or moderate intensity IPV during and around pregnancy; emotional neglect was associated with decreasing IPV class for combined model. Intervening early to disrupt this cycle of abuse is critical to two generations.     

Maternal smoking behavior, background and neonatal health in Finnish children subsequently placed in foster care

OBJECTIVE: The purpose of this study was to investigate retrospectively neonatal health and maternal background among a sample of children taken into custody and placed in foster care and to investigate the relation between medical and social risk in the neonatal period. METHOD: The data-linkage study combined two registries: the Finnish Medical Birth Registry (MBR), from January 1, 1987 to December 31, 1989, and the Finnish Child Welfare Registry (CWR) from January 1, 1987 to December 31, 1997 using personal identification numbers (n=1,668). As controls all Finnish children born in 1987 were chosen (n=59,727). Infant neonatal health was estimated using the following indicators: birth-weight and birth-length, birth-weight by gestational age, 1-minute Apgar scores, and discharge age from the nursery. Maternal background characteristics included maternal age, parity, marital status, number of antenatal visits at maternity clinics and smoking during pregnancy. RESULTS: We found that the 1,668 children in the study had a lower birth-weight and birth-length, shorter gestational age, lower 1-minute Apgar scores and later discharge from the nursery than the population-based controls. The proportion of teen-age mothers was about four times higher and the proportion of unmarried women was twice as high. A majority of the women (56%) reported smoking during pregnancy, compared with only 15% of the population-based comparisons. Children subsequently taken into custody had poorer health at the time of birth than other children and these differences could only partly be explained by the differences in smoking habits during pregnancy. The women in the study made use of the free health controls at maternity clinics as much as the population-based comparisons. CONCLUSIONS: Our findings indicate that social and medical risks are related in the neonatal period. Since almost all mothers visit maternity clinics, there are possibilities for early intervention.     

Prenatal Risk and Infant Regulation: Indirect Pathways via Fetal Growth and Maternal Prenatal Stress and Anger

Pathways from maternal tobacco, marijuana, stress, and anger in pregnancy to infant reactivity and regulation (RR) at 9 months of infant age were examined in a low‐income, diverse sample beginning in the first trimester of pregnancy, with fetal growth and postnatal stress/anger as potential mediators, and infant sex as a moderator. Participants were 247 dyads (173 substance‐exposed infants). There were no direct effects of prenatal risk on RR and no moderation by sex. However, there were significant indirect effects on RR via poor fetal growth and higher postnatal anger. The study adds to the sparse literature on joint effects of tobacco and marijuana, and highlights the role of fetal growth and maternal anger as important pathways from prenatal risk to infant RR.     

High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds

Associations between antenatal maternal anxiety, measured with the State Trait Anxiety Inventory, and disorders in 8- and 9-year-olds were studied prospectively in 71 normal mothers and their 72 firstborns. Clinical scales were completed by the mother, the child, the teacher, and an external observer. Hierarchical multiple regression analyses showed that maternal state anxiety during pregnancy explained 22%, 15%, and 9% of the variance in cross-situational attention deficit hyperactivity disorder symptoms, externalizing problems, and self-report anxiety, respectively, even after controlling for child's gender, parents' educational level, smoking during pregnancy, birth weight, and postnatal maternal anxiety. Anxiety at 12 to 22 weeks postmenstrual age turned out to be a significant independent predictor whereas anxiety at 32 to 40 weeks was not. Results are consistent with a fetal programming hypothesis.     

Maternal Sleep-Related Cognitions and Infant Sleep: A Longitudinal Study From Pregnancy Through the 1st Year

Infant sleep is a major source of concern for many parents. The aims of this longitudinal study were to assess: (a) the development of sleep patterns among infants, (b) the development of maternal cognitions regarding infant sleep, and (c) the relations between these domains during the 1st year of life. Eighty-five mothers were recruited during pregnancy and completed a questionnaire aimed at assessing maternal sleep-related cognitions. After delivery (at 1, 6, and 12 months) sleep was assessed using actigraphy and sleep logs, and maternal cognitions were reassessed. The findings demonstrated significant predictive and concomitant links between maternal cognitions and infant sleep. Maternal soothing behaviors mediated the relations between these domains.     

Maternal psychological distress during pregnancy in relation to child development at age two

Concern exists that a constellation of negative maternal emotions during pregnancy generates persistent negative consequences for child development. Maternal reports of anxiety, pregnancy-specific and nonspecific stress, and depressive symptoms were collected during mid-pregnancy and at 6 weeks and 24 months after birth in a sample of healthy women with low risk pregnancies. Developmental assessment and cardiac vagal tone monitoring were administered to 94 children at age 2. Higher levels of prenatal anxiety, nonspecific stress, and depressive symptoms were associated with more advanced motor development in children after postnatal control for each psychological measure; anxiety and depression were also significantly and positively associated with mental development. Mild to moderate levels of psychological distress may enhance fetal maturation in healthy populations.     

The Child Abuse Potential Inventory and pregnancy outcome in expectant adolescent mothers.

OBJECTIVE: The study explores the prenatal Child Abuse Potential (pCAP) scores derived from the Child Abuse Potential Inventory administered to expectant adolescent mothers. The aim of the study was to assess the association of the pCAP scores with maternal negative prenatal behaviors, and evaluate the contribution of the pCAP scores to neonatal morbidity. METHOD: The pCAP scores, demographic data, and self-report on prenatal behaviors were obtained during the second half of the pregnancy in a sample of 45 poor single adolescent mothers. A pediatrician blind to the prenatal data reviewed the neonatal records to assess neonatal morbidity. Maternal prenatal records were reviewed for obstetric risk assessment by an obstetrician who was blind to the rest of the data. The relations among the pCAP scores, prenatal behaviors, and neonatal morbidity were analyzed. RESULTS: In the prenatal period, the pCAP scores were positively correlated with self-reported prenatal smoking and substance use. The multiple linear regression analysis showed that the pCAP scores significantly contributed to neonatal morbidity independently of obstetric risk factors. CONCLUSIONS: The Child Abuse Potential scores obtained during pregnancy in poor single adolescent mothers reflect domains of maternal functioning that are associated with negative prenatal behaviors and appear to be important for predicting neonatal morbidity. Further studies are warranted to validate the prenatal use of the Child Abuse Potential Inventory.     

The Timing of Prenatal Exposure to Maternal Cortisol and Psychosocial Stress Is Associated With Human Infant Cognitive Development

The consequences of prenatal maternal stress for development were examined in 125 full-term infants at 3, 6, and 12 months of age. Maternal cortisol and psychological state were evaluated 5 times during pregnancy. Exposure to elevated concentrations of cortisol early in gestation was associated with a slower rate of development over the 1st year and lower mental development scores at 12 months. Elevated levels of maternal cortisol late in gestation, however, were associated with accelerated cognitive development and higher scores at 12 months. Elevated levels of maternal pregnancy-specific anxiety early in pregnancy were independently associated with lower 12-month mental development scores. These data suggest that maternal cortisol and pregnancy-specific anxiety have programming influences on the developing fetus.     

Fish Oil Supplementation in Pregnancy and Neurodevelopment in Childhood—A Randomized Clinical Trial

A double-blind randomized controlled trial of n-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) supplementation or matching placebo during third trimester of pregnancy was conducted within the COPSAC₂₀₁₀ mother-child cohort consisting of 736 women and their children. The objective was to determine if maternal n-3 LCPUFA pregnancy supplementation affects offspring neurodevelopment until 6 years. Neurodevelopment was evaluated in 654 children assessing age of motor milestone achievement, language development, cognitive development, general neurodevelopment, and emotional and behavioral problems. Maternal n-3 LCPUFA supplementation during pregnancy improved early language development and reduced the impact of emotional and behavioral problems. The n-3 LCPUFA supplementation was in boys associated with the earlier achievement of gross motor milestones, improved cognitive development, and a reduced impact of emotional and behavioral problems.     

Association of maternal developmental disorder traits with child mistreatment: A prospective study in Japan

Maternal mental disorders are known risk factors for child mistreatment. However, little is known about the involvement of maternal developmental disorder traits. The aim of this study was to examine maternal traits related to Pervasive Developmental Disorder (PDD) and Attention Deficit Hyperactivity Disorder (ADHD), and their possible association with child mistreatment. Maternal PDD and ADHD were assessed through a self-administered questionnaire (N = 846) during mid-pregnancy using the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) and Adult ADHD Self-Report Scale (ASRS). The mothers completed another questionnaire on child mistreatment when the offspring was approximately 18 months of age. The associations between maternal PDD and ADHD traits and child mistreatment score were analyzed using linear regression models adjusted for covariates. Mothers who exhibited stronger PDD traits showed significantly higher child mistreatment score, even after adjustment for maternal characteristics at baseline and ADHD traits. At the same time, ADHD traits were significantly associated with child mistreatment after adjustment of covariates, although the association became non-significant after adjustment of PDD traits. Mothers who showed PDD and ADHD traits during pregnancy were more likely to mistreat their children. It is essential to educate mothers with such traits with appropriate, easy-to-follow childcare instructions, preferably in simple language combined with pictorial aids.     

Prenatal Maternal Stress,Child Cortical Thickness,and Adolescent Depressive Symptoms

Prenatal maternal stress predicts subsequent elevations in youth depressive symptoms, but the neural processes associated with these links are unclear. This study evaluated whether prenatal maternal stress is associated with child brain development, and adolescent depressive symptoms using a prospective design with 74 mother child pairs (40 boys). Maternal stress was assessed during pregnancy, child cortical thickness at age 7, and depressive symptoms at age 12. Prenatal maternal stress was associated with less cortical thickness primarily in frontal and temporal regions and with elevated depressive symptoms; child cortical thickness additionally correlated with adolescent depressive symptoms. The observed associations are consistent with the possibility that cortical thickness in superior frontal regions links associations between prenatal maternal stress and adolescent depressive symptoms.     

Early Malnutrition and Child Neurobehavioral Development: Insights from the Study of Children of Diabetic Mothers

In this study we sought to discern whether disturbances in mothers' metabolism during pregnancy may exert long-range effects on the neurobehavioral development of the progeny. Participants were 139 Women with diabetes in pregnancy and their singleton offspring. Serial estimates of circulating maternal fuels were obtained for each pregnancy, along with detailed records of perinatal course and outcome. Offspring were administered the Wechsler Intelligence Scale for children—Revised (WISC-R) full-scale IQ scores below 70 in our cohort did not differ significantly from national estimates. Nonetheless, after statistically controlling for other influences, WISC-R verbal, performance, and full-scale IQ scores, and Bannatyne's indices of Verbal Conceptualization Ability, Acquired Knowledge, Spatial Ability, and Sequencing Ability were inversely correlated with measures, of maternal lipid and glucose metabolism in the second and third trimesters. KTEA Arithmetic scores were similarly correlated with measures of maternal lipids in the third trimester. All correlations indicate that poorer metabolic regulation was attended by poorer child performance. The effects of maternal metabolism on fetal brain and neurobehavioral development are discussed as potential intermediary factors.     

Maternal Sensitivity: Components and Relations to Warmth and Contingency

Objective. In this article, maternal sensitivity as a measure of parenting quality is analyzed for (1) situational independence, (2) interrelations among components of sensitivity (signal perception, correct interpretation, prompt, and appropriate reaction), and (3) relations to emotional warmth and behavioral contingency. Design. The interactions of 60 mother - infant pairs at 3 months were videotaped in contexts of caregiving and free-play in their homes. Maternal sensitivity and its components were evaluated separately in each context and in combination. Maternal emotional warmth and behavioral contingency were considered in terms of their effects on both positive and negative infant signals. Results. Maternal sensitivity ratings reflected in free-play interactions were more consistent with the general measure from both contexts than was the case for caregiving interactions. The components of sensitivity were interrelated, indicating a unified understanding of the concept of sensitivity by the raters. Conclusions. Maternal emotional warmth during the expression of positive infant signals seems to be related to maternal sensitivity. In contrast, maternal emotional warmth during the expression of negative infant signals, and contingency in general, do not seem to be related to sensitivity. This study contributes to understanding the concept of maternal sensitivity and demonstrates that it can be closely related to maternal warmth during the expression of positive infant signals.     

Fetal growth,fetal development,and placental features in women with polycystic ovary syndrome: analysis based on fetal and placental magnetic resonance imaging

Objective: Polycystic ovary syndrome (PCOS), a common endocrine-metabolic dysfunction in reproductive-aged women, may be involved in compromised pregnancy and offspring outcomes. This study aimed to investigate whether maternal PCOS affects fetal growth, fetal development, and placental features. Methods: This retrospective case-control study included 60 pregnant women with PCOS (PCOS group) and 120 healthy pregnant women without PCOS (control group). Fetal magnetic resonance imaging (MRI) was performed followed by an ultrasound examination and indications for imaging, including known or suspected fetal pathology, history of fetal abnormality in previous pregnancy or in a family member, and concern for placenta accreta. Fetal MRI images were analyzed for head circumference (HC), abdomen circumference (AC), lung-to-liver signal intensity ratio (LLSIR, a prenatal marker of fetal lung maturity), lengths of liver and kidney diameters in fetuses, and placental relative signal intensity on T2-weighted single-shot fast spin echo (SSFSE) imaging (rSI_SSFSE), and placental relative apparent diffusion coefficient value (rADC). Data on height and weight of offspring were collected through telephone follow-up. Results: Compared to the control group, the PCOS group showed the following characteristics: (1) smaller biparietal diameter and femur length in fetuses (P=0.026 and P=0.005, respectively), (2) smaller HC in fetuses (evident after 32 weeks; P=0.044), (3) lower LLSIR and smaller dorsoventral length of liver in fetuses (evident before 32 weeks; P=0.005 and P=0.019, respectively), and (4) smaller placental thickness (evident before 32 weeks; P=0.017). No significant differences in placental rSI_SSFSE or rADC were observed between the groups (all P>0.05). No significant differences in height and weight of offspring during childhood existed between the groups (all P>0.05). Conclusions: There exist alterations of fetal growth, fetal development, and placental features from women with PCOS.     

Mothers' Antenatal Depression and Their Children's Antisocial Outcomes

Interviews of 120 British adolescents and their parents (80% of a random sample of antenatal patients drawn from a representative urban population and followed longitudinally) revealed that 40 (33%) had been arrested and/or had a diagnosis of DSM–IV conduct disorder by 16 years of age; of those, 18 (45%) had committed violent acts. Depression in pregnancy significantly predicted violence in adolescence, even after controlling for the family environment, the child's later exposure to maternal depression, the mother's smoking and drinking during pregnancy, and parents' antisocial behavior. Mothers with a history of conduct problems were at elevated risk to become depressed in pregnancy, and the offspring of depressed women had a greater chance of becoming violent by age 16.     

Fetal pain: life in troubled waters

Maternal well-being is the key to fetal well-being. A fetus is highly vulnerable and sensitive to pain and stress, and exposure has the potential for negative developmental consequences. Childbirth educators can help raise parental awareness about the importance of the maternal environment for best outcomes in fetal development.     

Maternal regulation of sibling interactions in the preschool years: observational study in Japanese families

Characteristics of three maternal regulating behaviors--(1) reference to one sibling's actions or emotional states toward the other sibling, (2) encouragement of sibling interactions, (3) distraction of one sibling's attention away from the other sibling-and their associations with children's positive and negative behaviors toward their siblings were investigated through semistructured home observations for 40 sibling pairs (1-4 years, 2-8 years) and their mothers in Japanese families. Maternal regulating behaviors were observed more frequently when the younger sibling was still in an early developmental stage in the preschool years, although the findings were modest. The older sibling's negative behaviors toward the younger sibling positively correlated with maternal distraction toward the younger; alternatively, the younger sibling's negative behaviors do not correlate with maternal distraction but do correlate with maternal encouragement directed toward the older sibling. Reliable associations were found between maternal regulating behaviors and prosocial exchanges between siblings; maternal reference to the younger sibling's actions or emotional states directed toward the older sibling was associated with the older sibling's positive behavior toward the younger sibling. Maternal regulating behaviors during mother-sibling triadic interactions were associated with the quality of sibling relationships.     

Verbal abuse during pregnancy increases frequency of newborn hearing screening referral: The Japan Environment and Children’s Study

BackgroundVerbal abuse during pregnancy has a greater impact than physical and sexual violence on the incidence of postnatal depression and maternal abuse behavior towards their children. In addition, exposure of children (aged 12 months to adolescence) to verbal abuse from their parents exerts an adverse impact to the children’s auditory function. However, the effect of verbal abuse during pregnancy on fetal auditory function has not yet been thoroughly investigated.ObjectiveThe objective of the study was to examine the relationship between intimate partner verbal abuse during pregnancy and newborn hearing screening (NHS) referral, which indicates immature or impaired auditory function.Participants and settingThe Japan Environment and Children’s Study is an ongoing nationwide population-based birth-cohort study designed to determine environmental factors during and after pregnancy that affect the development, health, or wellbeing of children. Pregnant women living in 15 areas of Japan were recruited between January 2011 and March 2014.MethodsMultiple imputation for missing data was performed, followed by multiple logistic regression using 16 confounding variables.ResultsOf 104,102 records in the dataset, 79,985 mother–infant pairs submitted complete data for questions related to verbal and physical abuse and the results of NHS. Of 79,985 pregnant women, 10,786 (13.5%) experienced verbal abuse and 978 (1.2%) experienced physical abuse. Of 79,985 newborns, 787 (0.98%) received a NHS referral. Verbal abuse was significantly associated with NHS referral (adjusted odds ratio: 1.44; 95% confidence interval: 1.05–1.98).ConclusionsVerbal abuse should be avoided during pregnancy to preserve the newborn’s auditory function.     

Neurobehavioral Syndromes in Cocaine-exposed Newborn Infants

The effects of fetal cocaine exposure on newborn cry characteristics were studied in 80 cocaine-exposed and 80 control infants. The groups were stratified to be similar on maternal demographic characteristics and maternal use of other illegal substances and alcohol during pregnancy. The hypothesis was that excitable cry characteristics were related to the direct effects of cocaine, while depressed cry characteristics were related to the indirect effects of cocaine secondary to low birthweight. Structural equation modeling (EQS) showed direct effects of cocaine on cries with a longer duration, higher fundamental frequency, and a higher and more variable first formant frequency. Indirect effects of cocaine secondary to low birthweight resulted in cries with a longer latency, fewer utterances, lower amplitude, and more dysphonation. Cocaine-exposed infants had a lower birthweight, shorter length, and smaller head circumference than the unexposed controls. Findings were consistent with the notion that 2 neurobehavioral syndromes, excitable and depressed, can be described in cocaine-exposed infants, and that these 2 syndromes are due, respectively, to direct neurotoxic effects and indirect effects secondary to intrauterine growth retardation.